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% Document Info
\author{xkissmekatex (kissmekate)}
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  /Title (abg.pdf)
  /Creator (Cheatography)
  /Author (xkissmekatex (kissmekate))
  /Subject (ABG Cheat Sheet)
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\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{ABG Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{xkissmekatex (kissmekate)} via \textcolor{DarkBackground}{\uline{cheatography.com/33594/cs/10561/}}}
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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}xkissmekatex (kissmekate) \\
  \uline{cheatography.com/kissmekate} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 17th January, 2017.\\
   Page {\thepage} of \pageref{LastPage}.
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{0.89586 cm} x{4.08114 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Respiratory System (Acid) CO2 is a volatile acid}}  \tn
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Change & •The respiratory system can effect a change in 15-30 minutes \tn 
% Row Count 2 (+ 2)
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\seqsplit{ACIDOSIS} & • {\bf{Decrease your respiratory rate (hypoventilation)}} you {\bf{retain CO2}} (acid) therefore increasing your CO2 (acid) \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{ALKLAOSIS} & • {\bf{Increased respiratory rate (hyperventilation)}} "blow off" CO2 (acid) therefore {\bf{decreasing CO2}} acid \tn 
% Row Count 10 (+ 4)
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\end{tabularx}
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\begin{tabularx}{5.377cm}{x{1.59264 cm} x{3.38436 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{The Renal System (Base)}}  \tn
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Renal System (Base) & • Kidneys rid the body of the nonvolatile acids H+ (hydrogen ions) and {\bf{maintain a constant bicarb (HCO3}}). \{\{nl\}\} • Bicarbonate is the body's base \tn 
% Row Count 6 (+ 6)
% Row 1
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Acidosis & • {\bf{Kidneys}} try to adjust for this by {\bf{excreting H+ and retaining HCO3- base}}.  \{\{nl\}\} • {\bf{Respiratory System}} will try to {\bf{compensate by increasing ventilation to blow off CO2}} (acid) and therefore decrease the Acidosis.\{\{nl\}\} • Have {\bf{excess H+ and decreased HCO3}}- causing a decrease in pH. \tn 
% Row Count 18 (+ 12)
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Alkalosis & • {\bf{H+ decreases and you have excess (or increased) HCO3}}- base. \{\{nl\}\} • The {\bf{kidneys excrete HCO3}}- (base) and {\bf{retain H+ to compensate}}. \{\{nl\}\} • The {\bf{respiratory}} system tries to {\bf{compensates with hypoventilation}} to retain CO2 (acid) to decrease the alkalosis \tn 
% Row Count 29 (+ 11)
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Change & • The renal system takes several hours to days to have an effect. \tn 
% Row Count 32 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{The Land of the ABG}}  \tn
% Row 0
\SetRowColor{LightBackground}
The Last Name & • First, look at her pH (normal is 7.35 - 7.45) \{\{nl\}\} • If her pH is \textless{} 7.35; her name is ACIDOSIS \{\{nl\}\} • If her pH is \textgreater{} 7.45; her last name is ALKALOSIS \{\{nl\}\} • NOTE: To have an absolutely perfect last name; her pH needs to be 7.40. So, keep in mind that if her pH is 7.35 - 7.39 she's thinking about marrying into the ACIDOSIS family. If her pH is 7.41 - 7.45 she's thinking about marrying into the ALKALOSIS family \tn 
% Row Count 15 (+ 15)
% Row 1
\SetRowColor{white}
The First Name & • Look at her pH again. \{\{nl\}\} • If it is 7.35 - 7.45 (normal) then her first name is COMPENSATED. \{\{nl\}\} • If the pH is \textless{} 7.35 or \textgreater{} 7.45 then her first name is UNCOMPENSATED. \tn 
% Row Count 22 (+ 7)
% Row 2
\SetRowColor{LightBackground}
The Middle Name & • First you need to look at the CO2 and HCO3-. Remember : {\bf{normal CO2 35 - 45; and HCO3- 22 - 26}}. 1.\{\{nl\}\} • The middle name will either be Respiratory or Metabolic. 2.\{\{nl\}\} •  If the {\bf{CO2 is \textless{} 35 or \textgreater{} 45}} her middle name is RESPIRATORY. 3. \{\{nl\}\} • If the {\bf{HCO3- is \textless{} 22 or \textgreater{} 26}}; her middle name is METABOLIC. \tn 
% Row Count 34 (+ 12)
\end{tabularx}
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\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{The Land of the ABG (cont)}}  \tn
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The Family Feud & • {\bf{pH and HCO3}}- are "kissin' cousins" they like to {\bf{go in the same direction}} \{\{nl\}\}• CO2 is the "black sheep" pH runs the {\bf{opposite direction}} when it sees him Coming. THEREFORE:  \{\{nl\}\} • Decreased pH with decreased HCO3-: ACIDOSIS  \{\{nl\}\}• Increased pH with increased HCO3-: ALKALOSIS  \{\{nl\}\} • {\bf{Decreased pH with increased CO2}}-: ACIDOSIS  \{\{nl\}\} • {\bf{Increased pH with decreased CO2}}-: ALKALOSIS \tn 
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\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Metabolic Acidosis}}  \tn
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 & • pH \textless{} 7.35 (Normal: 7.35 - 7.45) HCO3- \textless{} 22 (normal: 22 – 26) \tn 
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% Row 1
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Causes & • {\bf{Increased H+, excess loss of HCO3-}} \{\{nl\}\} • Overproduction of organic acids (starvation, ketoacidosis, increased catabolism) \{\{nl\}\} • Impaired renal excretion of acid (renal failure) \{\{nl\}\} • Abnormal loss of HCO3- (diarrhea, biliary fistula, Diamox) \{\{nl\}\} • Ingestion of acid (salicylate overdose, oral anti-freeze) \tn 
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Signs and Symptoms & • CNS depression (confusion to coma) \{\{nl\}\} • Cardiac Dysrhythmias (elevated T wave, wide QRS to ventricular standstill) \{\{nl\}\} • Electrolyte abnormalities ({\bf{elevated K+, Cl-, Ca2+}}) \{\{nl\}\} • Flushed skin (arteriolar dilitation) \{\{nl\}\} • Nausea \tn 
% Row Count 34 (+ 13)
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\vfill
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\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Metabolic Acidosis (cont)}}  \tn
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Treatment (treat the underlying cause) & • NaHCO3- (sodium bicarbonate) based on ABGs only and with caution \{\{nl\}\} • IV fluids and insulin for DKA \{\{nl\}\} • Dialysis for renal failure \{\{nl\}\} • Antibiotics, increased nutrition for tissue catabolism \{\{nl\}\} • Increased cardiac output and tissue perfusion for low CO states \{\{nl\}\} • Rehydrate, monitor I and O \{\{nl\}\} • Treat dysrhythmias, support hemodynamic and respiratory status \tn 
% Row Count 20 (+ 20)
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\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Metabolic Alkalosis}}  \tn
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 & • pH \textgreater{} 7.45 (Normal: 7.35 - 7.45) HCO3- \textgreater{} 26 \tn 
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Causes & • Loss of H+ or increased HCO3- \{\{nl\}\} •  Loss of K+ (diarrhea, vomiting) \{\{nl\}\} • Ingestion of large amounts of bicarbonate (antacids, resuscitation) \{\{nl\}\} • Prolonged use of diuretics (distal tubule lose ability to reabsorb Na+ and Cl- therefore NaCl); Ammonia is in the urine and then binds with H+ \tn 
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Signs and Symptoms & • Similar to the disease process \{\{nl\}\} • Diaphoresis \{\{nl\}\} • Nausea and Vomiting \{\{nl\}\} • Increase neuromuscular excitability (Ca2+ binds with protein) \{\{nl\}\} • Shallow breathing (respiratory compensation) \{\{nl\}\} • EKG changes (increased QT, sinus tachycardia) \{\{nl\}\} • May also see confusion progressing to lethargy to coma \{\{nl\}\} • Electrolyte abnormality (decreased Ca2+), normal or decreased K+, increased base excess on the ABG \tn 
% Row Count 42 (+ 23)
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\vfill
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\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Metabolic Alkalosis (cont)}}  \tn
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Treatment (treat the underlying cause) & • Replace potassium (KCl) losses in 0.9\% NaCl (rehydrates and increases HCO3- excretion) \{\{nl\}\} • Diamox (acetazolamide, increases HCO3-excretion) \{\{nl\}\} • Monitor neuro status, re-orient, seizure precaution, monitor I and O \tn 
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\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{RESPIRATORY ACIDOSIS}}  \tn
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 & • pH \textless{} 7.35 (Normal: 7.35 - 7.45) CO2 \textgreater{} 45 (Normal: 35 – 45) \tn 
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Causes & • {\bf{Hypoventilation}}  • Depression of the Respiratory Center (sedatives, narcotics, drug overdose, CVA, cardiac arrest, MI).  \{\{nl\}\} •  Respiratory muscle paralysis (spinal cord injury, Guillian-Barre, paralytics). \{\{nl\}\} •   Chest wall disorders (flail chest, pneumothorax). \{\{nl\}\} •  Disorders of the lung parenchyma (CHF, COPD, pneumonia, aspiration, ARDS). \{\{nl\}\} •  Alteration in the function of the abdominal system (distension) \tn 
% Row Count 20 (+ 17)
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Signs and Symptoms & •CNS depression {\bf{(decreased LOC)}} \{\{nl\}\} •Muscle twitching which can progress to convulsions \{\{nl\}\} •Dysrhythmias, tachycardia, diaphoresis (related to hypoxia secondary to hypoventilation) \{\{nl\}\} •Palpitations \{\{nl\}\} •Flushed skin \{\{nl\}\} •Serum electrolyte abnormalities including elevated K+ (potassium leaves the cell to replace the H+ buffers leaving the cell) \tn 
% Row Count 34 (+ 14)
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\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.54287 cm} x{3.43413 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{RESPIRATORY ACIDOSIS (cont)}}  \tn
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Treatment & •Physically stimulate the patient to improve ventilation \{\{nl\}\} •Vigorous pulmonary toilet (chest PT, coughing and deep breathing, inspirometer, respiratory treatments with bronchodilators) \{\{nl\}\} •Mechanical ventilation (to {\bf{increase the respiratory rate and tidal volume}}) \{\{nl\}\} •Reversal of sedatives and narcotics \{\{nl\}\} •Antibiotics for infections \{\{nl\}\} •Diuretics for fluid overload \{\{nl\}\} •NOTE: beware of NaHCO3- sodium bicarbonate—can compensate and cause metabolic alkalosis. Also, if patient has been hypoxic and this is a lactic acidosis; NaHCO3- can be dangerous) \tn 
% Row Count 23 (+ 23)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Respiratory Alkalosis}}  \tn
% Row 0
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 & pH \textgreater{} 7.45 (Normal: 7.35 - 7.45) CO2 \textless{} 35 (Normal: 35 – 45) \tn 
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% Row 1
\SetRowColor{white}
Causes & •{\bf{ Alveolar Hyperventilation}} \{\{nl\}\} •Psychogenic (fear, pain, anxiety) \{\{nl\}\} •CNS stimulation (brain injury, ETOH, early salicylate poisoning, brain tumor) \{\{nl\}\} •Hypermetabolic states ({\bf{fever}}, thyrotoxicosis) \{\{nl\}\} •{\bf{Hypoxia}} (high altitude, pneumonia, heart failure, pulmonary embolism) \{\{nl\}\} •Mechanical overventilation ({\bf{ventilator rate too fast}}) \tn 
% Row Count 22 (+ 19)
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Signs and Symptoms & •Heachache \{\{nl\}\} •Vertigo \{\{nl\}\} •Paresthesias (numb fingers /toes, circumoral, carpal pedal spasms and tetany) \{\{nl\}\} •Tinnitus (ringing in the ears) \{\{nl\}\} •Electrolyte abnormalities ({\bf{decreased Ca+, K+}}) \tn 
% Row Count 33 (+ 11)
\end{tabularx}
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\vfill
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\begin{tabularx}{5.377cm}{x{2.43873 cm} x{2.53827 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Respiratory Alkalosis (cont)}}  \tn
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Treatment (treat the underlying cause) & •Sedatives or analgesics \{\{nl\}\} •Correction of hypoxia (possible diuretics, mechanical ventilation to also {\bf{decrease respiratory rate and decrease the tidal volume}}) \{\{nl\}\} •NOTE: patients with brain injury may need hyperventilation \{\{nl\}\} •Antipyretics for fever \{\{nl\}\} •Treat hyperthyroidism \{\{nl\}\} •Breathe into a paper bag for hyperventilation \tn 
% Row Count 19 (+ 19)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
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% That's all folks
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